Healthcare Provider Details

I. General information

NPI: 1508973280
Provider Name (Legal Business Name): OAK GROVE NURSING HOME INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 08/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6230 WARREN ST
GROVES TX
77619-4214
US

IV. Provider business mailing address

6230 WARREN ST
GROVES TX
77619-4214
US

V. Phone/Fax

Practice location:
  • Phone: 409-963-1266
  • Fax: 409-962-9622
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number5906
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number509601
License Number StateTX

VIII. Authorized Official

Name: DAN D FELLS
Title or Position: ADMINISTRATOR
Credential:
Phone: 409-963-1266